Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois Practitioner Fee Schedule (pdf)- Updated 04/01/09 - State of Illinois
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 80201 A 04 10/1/2008 N N 5.66 5.66 11.32 80202 A 04 10/1/2008 N N 6.64 6.64 13.28 80299 A 04 10/1/2008 Y N 80400 B 04 10/1/2008 N N 13.48 13.48 26.96 80402 B 04 10/1/2008 N N 22.29 22.29 44.58 80406 B 04 10/1/2008 N N 22.73 22.73 45.46 80408 B 04 10/1/2008 N N 61.43 61.43 122.86 80410 B 04 10/1/2008 N N 12.60 12.60 25.20 80412 B 04 10/1/2008 N N 80.89 80.89 161.78 80414 B 04 10/1/2008 N N 25.28 25.28 50.56 80415 B 04 10/1/2008 N N 10.20 10.20 20.40 80416 B 04 10/1/2008 N N 64.61 64.61 129.22 80417 B 04 10/1/2008 N N 21.54 21.54 43.08 80418 B 04 10/1/2008 Y N 80420 B 04 10/1/2008 N N 29.51 29.51 59.02 80422 B 04 10/1/2008 N N 19.99 19.99 39.98 80424 B 04 10/1/2008 N N 15.15 15.15 30.30 80426 B 04 10/1/2008 N N 60.11 60.11 120.22 80428 B 04 10/1/2008 N N 17.64 17.64 35.28 80430 B 04 10/1/2008 N N 24.39 24.39 48.78 80432 B 04 10/1/2008 N N 47.72 47.72 95.44 Wednesday, April 01, 2009 Page 310 of 458
Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty StateMax Surg Child Adult 80434 B 04 10/1/2008 N N 44.86 44.86 89.92 80435 B 04 10/1/2008 N N 33.30 33.30 66.60 80436 B 04 10/1/2008 N N 29.03 29.03 58.06 80438 B 04 10/1/2008 N N 24.68 24.68 49.36 80439 B 04 10/1/2008 N N 32.89 32.89 65.78 80440 B 04 10/1/2008 N N 20.23 20.23 40.46 80500 04 N N 12.40 80502 04 N N 49.80 81000 A 04 10/1/2008 N N 1.31 1.31 2.62 81001 A 04 10/1/2008 N N 1.43 1.43 2.86 81002 04 N N 1.30 1.30 2.60 81003 A 04 10/1/2008 N N 1.09 1.09 2.18 81005 A 04 10/1/2008 N N .86 .86 1.72 81007 A 04 10/1/2008 N N 1.26 1.26 2.52 81015 A 04 10/1/2008 N N 1.31 1.31 2.62 81020 A 04 10/1/2008 N N 1.39 1.39 2.78 81025 A 04 10/1/2008 N N 1.29 1.29 2.58 81050 A 04 10/1/2008 N N 1.28 1.28 2.56 81099 A 04 10/1/2008 Y N 82000 A 04 10/1/2008 N N 3.96 3.96 7.92 82003 A 04 10/1/2008 N N 3.96 3.96 7.92 Wednesday, April 01, 2009 Page 311 of 458
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Hcpcs Note ProgCov Eff Date HP NDC Ind SurgInd M1 (26) M2 (TC) Assist Surg Co-Surg Unitprice MaxQty <strong>State</strong>Max Surg Child Adult<br />
802<strong>01</strong> A <strong>04</strong> 10/1/2008 N N 5.66 5.66 11.32<br />
80202 A <strong>04</strong> 10/1/2008 N N 6.64 6.64 13.28<br />
80299 A <strong>04</strong> 10/1/2008 Y N<br />
8<strong>04</strong>00 B <strong>04</strong> 10/1/2008 N N 13.48 13.48 26.96<br />
8<strong>04</strong>02 B <strong>04</strong> 10/1/2008 N N 22.29 22.29 44.58<br />
8<strong>04</strong>06 B <strong>04</strong> 10/1/2008 N N 22.73 22.73 45.46<br />
8<strong>04</strong>08 B <strong>04</strong> 10/1/2008 N N 61.43 61.43 122.86<br />
8<strong>04</strong>10 B <strong>04</strong> 10/1/2008 N N 12.60 12.60 25.20<br />
8<strong>04</strong>12 B <strong>04</strong> 10/1/2008 N N 80.89 80.89 161.78<br />
8<strong>04</strong>14 B <strong>04</strong> 10/1/2008 N N 25.28 25.28 50.56<br />
8<strong>04</strong>15 B <strong>04</strong> 10/1/2008 N N 10.20 10.20 20.40<br />
8<strong>04</strong>16 B <strong>04</strong> 10/1/2008 N N 64.61 64.61 129.22<br />
8<strong>04</strong>17 B <strong>04</strong> 10/1/2008 N N 21.54 21.54 43.08<br />
8<strong>04</strong>18 B <strong>04</strong> 10/1/2008 Y N<br />
8<strong>04</strong>20 B <strong>04</strong> 10/1/2008 N N 29.51 29.51 59.02<br />
8<strong>04</strong>22 B <strong>04</strong> 10/1/2008 N N 19.99 19.99 39.98<br />
8<strong>04</strong>24 B <strong>04</strong> 10/1/2008 N N 15.15 15.15 30.30<br />
8<strong>04</strong>26 B <strong>04</strong> 10/1/2008 N N 60.11 60.11 120.22<br />
8<strong>04</strong>28 B <strong>04</strong> 10/1/2008 N N 17.64 17.64 35.28<br />
8<strong>04</strong>30 B <strong>04</strong> 10/1/2008 N N 24.39 24.39 48.78<br />
8<strong>04</strong>32 B <strong>04</strong> 10/1/2008 N N 47.72 47.72 95.44<br />
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